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Sartori AM, Kessler TM, Castro-Díaz DM, de Keijzer P, Del Popolo G, Ecclestone H, Frings D, Groen J, Hamid R, Karsenty G, Musco S, Padilla-Fernández B, Pannek J, Schouten N, van der Vorm A, Blok BFM. Summary of the 2024 Update of the European Association of Urology Guidelines on Neurourology. Eur Urol 2024; 85:543-555. [PMID: 38594103 DOI: 10.1016/j.eururo.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVE Most patients with neurourological disorders require lifelong medical care. The European Association of Urology (EAU) regularly updates guidelines for diagnosis and treatment of these patients. The objective of this review is to provide a summary of the 2024 updated EAU guidelines on neurourology. METHODS A structured literature review covering the timeframe 2021-2023 was conducted for the guideline update. A level of evidence and a strength rating were assigned for each recommendation on the basis of the literature data. KEY FINDINGS AND LIMITATIONS Neurological conditions significantly affect urinary, sexual, and bowel function, and lifelong management is required for neurourological patients to maintain their quality of life and prevent urinary tract deterioration. Early diagnosis and effective treatment are key, and comprehensive clinical assessments, including urodynamics, are crucial. Management should be customised to individual needs and should involve a multidisciplinary approach and address sexuality and fertility. Lifelong monitoring and follow-up highlight the importance of continuous care for neurourological patients. CONCLUSIONS AND CLINICAL IMPLICATIONS The 2024 EAU guidelines on neurourology provide an up-to-date overview of available evidence on diagnosis, treatment, and follow-up for neurourological patients. PATIENT SUMMARY Neurological disorders very frequently affect the lower urinary tract and sexual and bowel function and patients need lifelong management. We summarise the updated European Association of Urology guidelines on neurourology to provide patients and caregivers with the latest insights for optimal health care support.
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Affiliation(s)
- Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - David M Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Peter de Keijzer
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Giulio Del Popolo
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | | | - Dennis Frings
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Stefania Musco
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Jürgen Pannek
- Neuro-Urology Department, Swiss Paraplegic Center, Nottwil, Switzerland; Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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Welk B. Questionnaires for Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am 2024; 51:233-238. [PMID: 38609195 DOI: 10.1016/j.ucl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
The evaluation of people with neurogenic lower urinary tract dysfunction (NLUTD) often involves objective parameters, however quality of life (QOL) assessments are crucial for patient-centered care. This article discusses how to measure QOL and urinary symptoms in NLUTD and highlights various questionnaires such as the Qualiveen, Neurogenic Bladder Symptom Score (NBSS), and the Incontinence Quality of Life Questionnaire (I-QOL). These questionnaires focus on bladder-related QOL or symptoms and have been validated in multiple NLUTD populations. These tools are important for advancing research and the clinical care of NLUTD patients, and have the potential to impact decision-making and improve patient outcomes.
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Affiliation(s)
- Blayne Welk
- Department of Surgery, Western University, 268 Grosvenor Street, London, Onatrio N6A 4V2, Canada; Department of Epidemiology and Biostatistics, Western University, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada.
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Welk B, Krhut J, Sýkora R. An individual participant meta-analysis of mirabegron in multiple sclerosis and spinal cord injury. Neurourol Urodyn 2024; 43:803-810. [PMID: 38477368 DOI: 10.1002/nau.25439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/03/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Our objective was to conduct an individual patient data meta-analysis (IPDMA) of the two published randomized placebo-controlled trials of mirabegron in people with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) or multiple sclerosis (MS). METHODS We identified two randomized, placebo-controlled trials. We extracted individual patient data from the trials and evaluated two primary outcomes: change in maximum cystometric capacity and change in the patient perception of bladder condition (PPBC). We also evaluated several secondary outcomes related to urodynamic function and quality of life. We conducted three exploratory analyses to test hypotheses based on our clinical experiences with mirabegron in NLUTD. Analysis of covariance with adjustment for baseline values was used for the statistical analysis. RESULTS Our IPDMA included 98 patients from the two trials. The results showed that mirabegron was associated with a significant improvement in maximum cystometric capacity (+41 mL, p = 0.04) and in the PPBC (-0.8, p < 0.01) compared to placebo. Secondary outcomes including peak neurogenic detrusor overactivity pressure (-20 cm H2O, p < 0.01), incontinence-QOL score (+12, p < 0.01), and 24 h pad weights (-79 g, p = 0.04) also improved significantly compared to placebo. Exploratory analyses found similar improvements in people with MS and SCI; some outcomes improved to a greater degree among people with incomplete SCI, or SCIs that were below T7. CONCLUSIONS Our IPDMA provides evidence supporting the use of mirabegron in patients with NLUTD due to SCI or MS. Further work evaluating differential responses in people with different SCI lesion characteristics may be warranted.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic
| | - Radek Sýkora
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic
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Usman Ali M, Fong KNK, Kannan P, John Winser S, Muhammad Bello U, Salihu D, Kranz GS. Measures of quality of life of people with neurogenic overactive bladder: A systematic review of psychometric properties. Eur J Obstet Gynecol Reprod Biol 2024; 292:40-57. [PMID: 37976765 DOI: 10.1016/j.ejogrb.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To identify psychometrically robust quality-of-life (QOL) outcome measures for evaluating QOL among people with neurogenic overactive bladder (OAB). STUDY DESIGN Electronic databases (CINAHL, EMBASE, MEDLINE, Scopus and Web of Science) were searched from inception to January 2023. Two independent reviewers participated in study screening, data extraction and quality appraisal. Studies were included if they validated at least one psychometric property of a QOL outcome measure among adults (age ≥ 18 years) with neurogenic OAB. The COnsensus-based Standards for selecting health status Measurement INstruments (COSMIN) checklist and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool were used to evaluate the methodological quality and quality of evidence, respectively, for each included study. RESULTS Database searches identified 47 studies that tested the psychometric properties of 15 QOL measures in a total of 19,994 participants with stroke, spinal cord injury, Parkinson's disease or multiple sclerosis. The Incontinence Quality of Life Questionnaire (I-QOL), King's Health Questionnaire, Overactive Bladder Questionnaire and Qualiveen were the best validated measures, with strong reliability, validity and responsiveness. I-QOL was the most robust, cross-culturally administered and psychometrically strong measure. The COSMIN checklist indicated sufficient methodological quality for 70% of measures, and the modified GRADE tool indicated quality of evidence ranging from moderate (67%) to high (33%). CONCLUSIONS This review identified the I-QOL as a culturally diverse measure with robust reliability, validity and responsiveness for assessing QOL among people with neurogenic OAB. These findings are supported by studies with good methodological quality (COSMIN) and high-quality evidence (GRADE).
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Affiliation(s)
- Mohammed Usman Ali
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Stanley John Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Umar Muhammad Bello
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Dauda Salihu
- College of Nursing, Jouf University, Sakaka, Saudi Arabia
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong; Department of Psychiatry and Psychotherapy, Comprehensive Centre for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria
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Yang Y, Li Z, Si K, Dai Q, Qiao Y, Li D, Zhang L, Wu F, He J, Wu G. Effectiveness of Laparoscopic Pectopexy for Pelvic Organ Prolapse Compared with Laparoscopic Sacrocolpopexy. J Minim Invasive Gynecol 2023; 30:833-840.e2. [PMID: 37369345 DOI: 10.1016/j.jmig.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
STUDY OBJECTIVE To evaluate the clinical benefits of laparoscopic pectopexy vs laparoscopic sacrocolpopexy in women with pelvic organ prolapse (POP). DESIGN Prospective cohort study. SETTING A tertiary hospital. PATIENTS We included 203 patients with POP. INTERVENTIONS Laparoscopic pectopexy or laparoscopic sacrocolpopexy. MEASUREMENTS AND MAIN RESULTS Anatomic effectiveness was measured using the POP Quantification system, both before and after operation. Functional recovery effectiveness was evaluated using complications and recurrence rates within 1 year. Quality of life was assessed by the Pelvic Floor Distress Inventory-20 and Incontinence Quality of Life questionnaires at enrollment and postoperative months 3, 6, and 12. Comparisons between groups were performed using t test, chi-square test, and mixed-effects model with repeated measures. The analysis included 203 eligible patients (sacrocolpopexy, 101; pectopexy, 102). The proportion of robotic-assisted surgeries was lower in the pectopexy group than in the sacrocolpopexy group (15.7% vs 41.6%, p <.001). The average operation time of pectopexy was shorter than that of sacrocolpopexy (174.2 vs 187.7 minutes) with a mean difference of 13.5 minutes (95% confidence interval, 3.9-23.0; p = .006). Differences of intraoperative blood loss, length of hospital stay, and postoperative 7-day complications between groups were not significant. Anatomic successes were obtained in both groups with similar improvement in POP Quantification scores. The rate of urinary symptoms recurrence was higher in the pectopexy group (13.7%) than in the sacrocolpopexy group (5.0%) at the 1-year follow-up (odds ratio, 3.1; 95% confidence interval, 1.1-8.8, p = .032). The Pelvic Floor Distress Inventory-20 and Incontinence Quality of Life scores were better improved at postoperative months 3, 6, and 12 for laparoscopic pectopexy than for sacrocolpopexy. CONCLUSION Laparoscopic pectopexy revealed comparable anatomic success, shorter operation time, and better improvement in quality of life scores of prolapse, colorectal-anal, and urinary symptoms at 1-year follow-up, possibly being an alternative when sacrocolpopexy is not practicable. However, clinicians should pay more attention to the recurrence of urinary symptoms after pectopexy.
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Affiliation(s)
- Yingying Yang
- Clinical Research Unit (Drs. Yang and Z. Li), Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhen Li
- Clinical Research Unit (Drs. Yang and Z. Li), Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Keyi Si
- Department of Military Health Statistics (Dr. Si), Naval Medical University, Shanghai, China
| | - Qingqiang Dai
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yingying Qiao
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dazhuang Li
- School of Public Health (Dr. D. Li), Fudan University, Shanghai, China
| | - Li Zhang
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fan Wu
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jia He
- School of Medicine (Dr. He), Tongji University, Shanghai, China
| | - Guizhu Wu
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
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Miller T, Lange D, Kizhakkedathu JN, Yu K, Felix D, Samejima S, Shackleton C, Malik RN, Sachdeva R, Walter M, Krassioukov AV. The Microbiological Burden of Short-Term Catheter Reuse in Individuals with Spinal Cord Injury: A Prospective Study. Biomedicines 2023; 11:1929. [PMID: 37509568 PMCID: PMC10377649 DOI: 10.3390/biomedicines11071929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Despite the risk of developing catheter-associated urinary tract infections (CAUTI), catheter reuse is common among people with spinal cord injury (SCI). This study examined the microbiological burden and catheter surface changes associated with short-term reuse. Ten individuals with chronic SCI reused their catheters over 3 days. Urine and catheter swab cultures were collected daily for analysis. Scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analyses were used to assess catheter surface changes. Catheter swab cultures showed no growth after 48 h (47.8%), skin flora (28.9%), mixed flora (17.8%), or bacterial growth (5.5%). Asymptomatic bacteriuria was found for most participants at baseline (n = 9) and all at follow-up (n = 10). Urine samples contained Escherichia coli (58%), Klebsiella pneumoniae (30%), Enterococcus faecalis (26%), Acinetobacter calcoaceticus-baumannii (10%), Pseudomonas aeruginosa (6%) or Proteus vulgaris (2%). Most urine cultures showed resistance to one or more antibiotics (62%). SEM images demonstrated structural damage, biofilm and/or bacteria on all reused catheter surfaces. XPS analyses also confirmed the deposition of bacterial biofilm on reused catheters. Catheter surface changes and the presence of antibiotic-resistant bacteria were evident following short-term reuse, which may increase susceptibility to CAUTI in individuals with SCI despite asymptomatic bacteriuria.
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Affiliation(s)
- Tiev Miller
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Dirk Lange
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The Stone Centre at Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Jayachandran N Kizhakkedathu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Centre for Blood Research, Life Science Institute, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The School of Biomedical Engineering, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Kai Yu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Centre for Blood Research, Life Science Institute, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Demian Felix
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The Stone Centre at Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Soshi Samejima
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Claire Shackleton
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Raza N Malik
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada
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Mishra B, Sudheer P, Agarwal A, Srivastava MVP, Nilima, Vishnu VY. Minimal Clinically Important Difference (MCID) in Patient-Reported Outcome Measures for Neurological Conditions: Review of Concept and Methods. Ann Indian Acad Neurol 2023; 26:334-343. [PMID: 37970301 PMCID: PMC10645230 DOI: 10.4103/aian.aian_207_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/29/2023] [Accepted: 05/10/2023] [Indexed: 11/17/2023] Open
Abstract
The concept of the minimal clinically important difference (MCID) emerged from the recognition that statistical significance alone is not enough to determine the clinical relevance of treatment effects in clinical research. In many cases, statistically significant changes in outcomes may not be meaningful to patients or may not result in any tangible improvements in their health. This has led to a growing emphasis on the importance of measuring patient-reported outcome measures (PROMs) in clinical trials and other research studies, in order to capture the patient perspective on treatment effectiveness. MCID is defined as the smallest change in scores that is considered meaningful or important to patients. MCID is particularly important in fields such as neurology, where many of the outcomes of interest are subjective or based on patient-reported symptoms. This review discusses the challenges associated with interpreting outcomes of clinical trials based solely on statistical significance, highlighting the importance of considering clinical relevance and patient perception of change. There are two main approaches to estimating MCID: anchor-based and distribution-based. Anchor-based approaches compare change scores using an external anchor, while distribution-based approaches estimate MCID values based on statistical characteristics of scores within a sample. MCID is dynamic and context-specific, and there is no single 'gold standard' method for estimating it. A range of MCID thresholds should be defined using multiple methods for a disease under targeted intervention, rather than relying on a single absolute value. The use of MCID thresholds can be an important tool for researchers, neurophysicians and patients in evaluating the effectiveness of treatments and interventions, and in making informed decisions about care.
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Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pachipala Sudheer
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Nilima
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Chawla A, Patil MC, Reddy SJ, Pillai S, N SSB. Global Differences in Management of Neurogenic Bladder: Indian Perspective. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Wang Y, Chen W, Li W. To Compare the Effects of two Pelvic Floor Muscle Treatments on Quality of Life and Sexual Function in Female Patients With Urinary Incontinence. Sex Med 2022; 10:100561. [PMID: 36037676 PMCID: PMC9537268 DOI: 10.1016/j.esxm.2022.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background Adjuncts used clinically to improve the efficacy of Pelvic floor muscle training (PFMT) include electromyographic biofeedback (EB) and electrical stimulation (ES). Aim The purpose of this study was to investigate the effects of PFMT on patients' quality of life and sexual function in UI treatment. Different PFMT with different EB + ES treatments were designed in this study. In order to distinguish between 10 minutes of electrical stimulation at the beginning of PFMT treatment to fully arouse the patient's body response and then Kegel training, or one electric stimulation and a Kegel action, which is better. For this purpose, we designed two different treatment groups: 10ES-20EB and 15ES-15EB.Whether changing pelvic floor treatment regimen can better improve quality of life and sexual function in female patients with urinary incontinence? Methods Patients diagnosed urinary incontinence (UI) were from January 2020 to April 2021 at our Hospital, Jiangsu Province. Outcome Primary outcome including I-QOL and PISQ-12, and secondary outcome including measurements of pelvic floor musculature by glazer method were compared before and after treatment in both groups. Results 78 patients were enrolled including 37 cases in 10ES-20EB group and 41 in 15ES-15EB group. Both groups made similar gains in quality of life and sexual function.There was no statistical difference between the two groups in Glazer total score and I-QOL and PISQ-12 questionnaire results. However, 15ES-15EB significantly improved the flick contractions average peak more than the 10ES-20EBgroup(P < 0.05). Clinical Implications Pelvic floor muscle training is a commonly recommended physical therapy treatment that has been shown to improve the outcome of UI, Comparison of the main observation indicators I-QOL and PISQ-12 before and after treatment between the two groups have good clinical significance Strengths and Limitations The sample is single, the sample size is small, and the participating patients are all from the same hospital. Conclusions These two different pelvic floor muscle treatment (10ES-20EB and 15ES-15EB)were examined and found to may improve the quality of life and sexual function of women with UI. Wang Y, Chen W, Li W. To Compare the Effects of two Pelvic Floor Muscle Treatments on Quality of Life and Sexual Function in Female Patients With Urinary Incontinence. Sex Med 2022;10:100561.
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Affiliation(s)
- Yiqun Wang
- Zhenjiang Maternal and Child Health Hospital, Zhenjiang, Jiangsu Province, China
| | | | - Wei Li
- Zhenjiang Maternal and Child Health Hospital, Zhenjiang, Jiangsu Province, China.
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Darrow DP, Balser DY, Freeman D, Pelrine E, Krassioukov A, Phillips A, Netoff T, Parr A, Samadani U. Effect of epidural spinal cord stimulation after chronic spinal cord injury on volitional movement and cardiovascular function: study protocol for the phase II open label controlled E-STAND trial. BMJ Open 2022; 12:e059126. [PMID: 35851008 PMCID: PMC9297213 DOI: 10.1136/bmjopen-2021-059126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) leads to significant changes in morbidity, mortality and quality of life (QOL). Currently, there are no effective therapies to restore function after chronic SCI. Preliminary studies have indicated that epidural spinal cord stimulation (eSCS) is a promising therapy to improve motor control and autonomic function for patients with chronic SCI. The aim of this study is to assess the effects of tonic eSCS after chronic SCI on quantitative outcomes of volitional movement and cardiovascular function. Our secondary objective is to optimise spinal cord stimulation parameters for volitional movement. METHODS AND ANALYSIS The Epidural Stimulation After Neurologic Damage (ESTAND) trial is a phase II single-site self-controlled trial of epidural stimulation with the goal of restoring volitional movement and autonomic function after motor complete SCI. Participants undergo epidural stimulator implantation and are followed up over 15 months while completing at-home, mobile application-based movement testing. The primary outcome measure integrates quantity of volitional movement and similarity to normal controls using the volitional response index (VRI) and the modified Brain Motor Control Assessment. The mobile application is a custom-designed platform to support participant response and a kinematic task to optimise the settings for each participant. The application optimises stimulation settings by evaluating the parameter space using movement data collected from the tablet application and accelerometers. A subgroup of participants with cardiovascular dysautonomia are included for optimisation of blood pressure stabilisation. Indirect effects of stimulation on cardiovascular function, pain, sexual function, bowel/bladder, QOL and psychiatric measures are analysed to assess generalisability of this targeted intervention. ETHICS AND DISSEMINATION This study has been approved after full review by the Minneapolis Medical Research Foundation Institutional Review Board and by the Minneapolis VA Health Care System. This project has received Food and Drug Administration investigational device exemption approval. Trial results will be disseminated through peer-reviewed publications, conference presentations and seminars. TRIAL REGISTRATION NUMBER NCT03026816.
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Affiliation(s)
- David P Darrow
- Neurosurgery, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
- Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - David Young Balser
- Rehabilitation Medicine, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
| | - David Freeman
- Neurosurgery, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
| | - Eliza Pelrine
- Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Andrei Krassioukov
- Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron Phillips
- Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Theoden Netoff
- Biomedical Engineering, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Ann Parr
- Neurosurgery, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
| | - Uzma Samadani
- Surgery, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
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11
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Viaene AM, Roggeman S, Vanhaute OA, Raes A, Colman R, Everaert K. Nocturnal bladder emptying and Quality of Life in patients with spinal cord injury. Eur J Phys Rehabil Med 2022; 58:397-404. [PMID: 34652085 PMCID: PMC9980489 DOI: 10.23736/s1973-9087.21.07104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Little is known about the relationship between sleep disruption due to nocturnal bladder emptying and Quality of Life in patients with spinal cord injury. AIM The aim of this study was to evaluate the possible influence of number of nocturnal bladder emptying, bladder emptying method and nocturnal incontinence on the Quality of Life of patients with spinal cord injury. DESIGN The design of this paper is a cross-sectional descriptive study. SETTING The setting is in- and outpatient. POPULATION Seventy-nine patients aged between 18 and 77 years with SCI in a first rehabilitation period or follow-up. METHODS Patients were asked to complete Short Form-36 and Incontinence Quality of Life questionnaires and a medical information form. Independent samples t-tests and ANOVA were used to compare scores between groups. RESULTS The response rate was 71 out of 79 (89%; 51 males and 20 females). 16 paraplegic and 4 tetraplegic patients were chronic, 29 paraplegic and 22 tetraplegic patients were in rehabilitation therapy or had finished this treatment recently. The paraplegic group had a significantly better Short Form-36 total score and emotional function score, while the tetraplegic group had a significantly better Incontinence Quality of Life total score and avoidance and limiting behavior score. The paraplegic patients with 0-1 nocturnal bladder emptying had better Short Form-36-derived Quality of Life than those with ≥2 emptying. Quality of Life score was not associated with gender, leg oedema, incontinence, or acute/chronic group. Incontinence Quality of Life score was significantly better for patients with incomplete spinal cord injury. Fully completed questionnaires were returned by 36 patients; at least 1 item was missing for 35 participants. CONCLUSIONS General Short Form-36-derived Quality of Life was better for the paraplegic population. Incontinence-related Quality of Life was better in tetraplegic patients, most of whom used suprapubic catheterization. Paraplegic patients had compromised sleep and Quality of Life when the patient had to wake up two or more times at night to empty the bladder by voiding or intermittent catheterization. The high number of incomplete responders indicates the shortcomings of Quality-of-Life questionnaires for wheelchair-bound patients with spinal cord injury. CLINICAL REHABILITATION IMPACT The use of suprapubic catheterization should be considered to improve Quality of Life for tetraplegic patients. For paraplegic patients, we must focus urological policy on aiming to reduce the number of nighttime bladder emptying to one or none.
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Affiliation(s)
- Annick M Viaene
- Department of Physical Medicine and Orthopedic Surgery, Ghent University Hospital, Ghent, Belgium -
| | - Saskia Roggeman
- Department of Urology, Ghent University Hospital, Ghent, Belgium.,Department of Research and Policy, Psychiatric Center Sint-Jan-Baptist, Zelzate, Belgium
| | - Omer A Vanhaute
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Roos Colman
- Unit of Biostatistics, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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12
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Yuanzhuo C, Liao P, Chi Z, Boya L, Deyi L. The efficacy and safety of mirabegron for adult and child patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‐analysis. Neurourol Urodyn 2022; 41:1056-1064. [PMID: 35373855 DOI: 10.1002/nau.24928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/06/2022] [Accepted: 03/07/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Chen Yuanzhuo
- Department of Urology, Institute of Urology, West China Hospital Sichuan University Chengdu Sichuan P. R. China
| | - Peng Liao
- Department of Urology, Institute of Urology, West China Hospital Sichuan University Chengdu Sichuan P. R. China
| | - Zhang Chi
- Department of Urology, Institute of Urology, West China Hospital Sichuan University Chengdu Sichuan P. R. China
| | - Li Boya
- Department of Urology, Institute of Urology, West China Hospital Sichuan University Chengdu Sichuan P. R. China
| | - Luo Deyi
- Department of Urology, Institute of Urology, West China Hospital Sichuan University Chengdu Sichuan P. R. China
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13
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Efficacy and Safety of AbobotulinumtoxinA in Patients with Neurogenic Detrusor Overactivity Incontinence Performing Regular Clean Intermittent Catheterization: Pooled Results from Two Phase 3 Randomized Studies (CONTENT1 and CONTENT2). Eur Urol 2022; 82:223-232. [DOI: 10.1016/j.eururo.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/24/2022]
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14
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Ruseckaite R, Bavor C, Marsh L, Dean J, Daly O, Vasiliadis D, Ahern S. Evaluation of the acceptability of patient-reported outcome measures in women following pelvic floor procedures. Qual Life Res 2022; 31:2213-2221. [PMID: 35113307 PMCID: PMC9188490 DOI: 10.1007/s11136-022-03099-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are valuable tools in evaluating the outcomes of surgical treatment health-related quality of life (HRQoL) of women with stress urinary incontinence (SUI) and may be incorporated into related clinical quality registries. The aim of this study was to assess the feasibility and acceptability of incorporating PROMs into the Australian Pelvic Floor Procedure Registry (APFPR). METHODS Semi-structured qualitative interviews were conducted with women with SUI (N = 12) and their managing clinicians (N = 11) in Victoria, Australia. Interview topics covered content and face validity, appropriateness, and acceptability of three incontinence-specific, two pain, one anxiety and depression, one sexual function and one patient global impression of improvement instruments identified through the literature to determine their suitability and acceptability for the APFPR. We analysed interview data into topics using conventional content analysis. RESULTS Study participants agreed that PROMs were needed for the APFPR. Both participant groups suggested that some of the instruments were ambiguous, therefore only three instruments (one incontinence-specific, sexual function and patient global impression of improvement) will be included in the APFPR. Both clinicians and women agreed it would be appropriate to answer PROMs at baseline and then at 6- and 12-month postsurgically. Email, phone call and mail-out of the instruments were the preferred options for administration. CONCLUSION Most women and clinicians supported the feasibility of incorporating PROMs in the APFPR. Participants believed the PROMs would demonstrate useful aggregate HRQoL data and have potential for use in individual care.
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Affiliation(s)
- Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - Claire Bavor
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Lucy Marsh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Joanne Dean
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Oliver Daly
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.,Department of Obstetrics and Gynaecology, Western Health, Melbourne, VIC, Australia
| | - Dora Vasiliadis
- Consumer Representative, Australian Pelvic Floor Procedure Registry, Melbourne, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
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15
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Damuzzo V, Agnoletto L, Rampazzo R, Cammalleri F, Cancanelli L, Chiumente M, Costantino S, Michielan S, Milani F, Sartori A, Rivano M, Mengato D. The QOSMOS Study: Pharmacist-Led Multicentered Observational Study on Quality of Life in Multiple Sclerosis. Neurol Int 2021; 13:682-694. [PMID: 34940751 PMCID: PMC8706851 DOI: 10.3390/neurolint13040065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Health-related quality of life is frequently included in patient-reported outcomes aimed at evaluating the effectiveness of disease-modifying drugs for multiple sclerosis, but recent data about Italian patients are missing. A multicenter observational and cross-sectional study was performed by students of hospital pharmacy to update existing data on quality of life and to correlate it with the pharmacological and medical history of patients. Quality of life (QoL) was assessed using the MS-QoL54 questionnaire, and the pharmacist collected patients' characteristics, medical and pharmacological history, and Expanded Disability Status Scale (EDSS). Three hundred and forty-nine patients with multiple sclerosis were recruited from 16 centers between May 2018 and June 2019 (median age = 44.1 years; 68.9% women). The composite indexes of physical and mental well-being showed direct correlation with each other (R = 0.826; p < 0.001), and EDSS disability was an independent negative predictor of both indexes (R2 = 35.08% p < 0.001 and R2 = 15.74% p < 0.001, respectively). A trend of association between Physical Health Composite Score and different classes of oral disease-modifying drugs (DMDs) was observed. Our study found a decrease in QoL correlated with teriflunomide, which deserves further investigation. This experience demonstrates that joint action between scientific society and students association can be successful in conducting a no-profit multicenter observational study in a real-world setting.
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Affiliation(s)
- Vera Damuzzo
- Department of Pharmaceutical and Pharmacological Sciences, School of Hospital Pharmacy, University of Padua, 35122 Padua, Italy; (S.M.); (F.M.)
- National Association of Hospital Pharmacy Students-ReNaSFO, 20122 Milan, Italy
- Correspondence:
| | - Laura Agnoletto
- Pharmacy, Santa Maria della Misericordia Hospital, 45100 Rovigo, Italy;
| | - Roberta Rampazzo
- Regional Pharmaceutical Office, Veneto Region, 30125 Venice, Italy;
| | - Francesca Cammalleri
- Department of Pharmaceutical Sciences, School of Hospital Pharmacy, University of Milan, 20122 Milan, Italy; (F.C.); (L.C.); (M.R.)
| | - Luca Cancanelli
- Department of Pharmaceutical Sciences, School of Hospital Pharmacy, University of Milan, 20122 Milan, Italy; (F.C.); (L.C.); (M.R.)
| | - Marco Chiumente
- Italian Society of Clinical Pharmacy and Therapeutics-SIFaCT, 20159 Milan, Italy; (M.C.); (D.M.)
| | - Stefano Costantino
- Department of Drug Science and Technology, School of Hospital Pharmacy, University of Turin, 10124 Turin, Italy;
| | - Silvia Michielan
- Department of Pharmaceutical and Pharmacological Sciences, School of Hospital Pharmacy, University of Padua, 35122 Padua, Italy; (S.M.); (F.M.)
| | - Federica Milani
- Department of Pharmaceutical and Pharmacological Sciences, School of Hospital Pharmacy, University of Padua, 35122 Padua, Italy; (S.M.); (F.M.)
| | - Alessia Sartori
- Department of Food and Drug, School of Hospital Pharmacy, University of Parma, 43121 Parma, Italy;
| | - Melania Rivano
- Department of Pharmaceutical Sciences, School of Hospital Pharmacy, University of Milan, 20122 Milan, Italy; (F.C.); (L.C.); (M.R.)
| | - Daniele Mengato
- Italian Society of Clinical Pharmacy and Therapeutics-SIFaCT, 20159 Milan, Italy; (M.C.); (D.M.)
- Hospital Pharmacy Department, Azienda Ospedale-Università of Padova, 35121 Padua, Italy
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16
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Truzzi JC, de Almeida FG, Sacomani CA, Reis J, Rocha FET. Neurogenic bladder - concepts and treatment recommendations. Int Braz J Urol 2021; 48:220-243. [PMID: 34156189 PMCID: PMC8932021 DOI: 10.1590/s1677-5538.ibju.2021.0098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/15/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Bladder and urinary sphincter malfunctioning that results from some change in the central and/or peripheral nervous system is defined as neurogenic bladder. The urinary tract symptoms that can be related to its filling, emptying, or both have a significant impact on the quality of life of individuals. The present review was based on the document prepared for the public health system in Brazil as a treatment guidelines proposal. Material and Methods: Survey questions were structured as per PICO (Population, Intervention, Control, and Outcome). Search strategies were defined and performed in the MEDLINE/Pubmed, Embase, Epistemonikos and Google Scholar databases. The selection of articles followed the evidence hierarchy concept; evidence body was identified, and the quantitative study data were extracted. The quality of evidence and grade of recommendation were qualitatively assessed according to GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results: A total of 2.707 articles were identified, with 49 of them being selected to compose the basis for this review. Neurogenic bladder treatments were classified according to their focus on filling or emptying symptoms and sub- classified in pharmacological and surgical treatments. Conclusion: Treatment guidelines are important tools for the public health system to promote the best practice when treating neurogenic bladder patients.
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Affiliation(s)
- José Carlos Truzzi
- Departamento de Assuntos Médicos, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
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17
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Aliyu SU, Hanif SM, Lawal IU. Effect of Paula exercise method on functional outcomes of women with post fistula repair incontinence: a protocol for randomized controlled trial. BMC WOMENS HEALTH 2021; 21:101. [PMID: 33750376 PMCID: PMC7941917 DOI: 10.1186/s12905-021-01249-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Post-fistula-repair incontinence (PFRI) is a common complication of vesicovaginal fistula (VVF) surgeries. It entails continuous leakage of urine after successful VVF closure. Pelvic Floor Muscle Training (PFMT) plays a vital role in the management of PFRI, however, an evolving exercise approach is the Paula Exercise Method (PEM) which has shown a promising effect in stopping urinary incontinence, but there is no data on its effect on PFRI. This study therefore, proposes to primarily investigate the effect of PEM on urine leakage and secondarily, pelvic floor strength (PFS), quality of life (QoL), sexual function (SF), and mental health (MH) in women with PFRI. METHODS This is a study protocol for a randomized controlled trial. A total of 182 participants are expected to participate in the study after satisfying the inclusion criteria. The participants will be randomized into either PEM or PFMT study groups. The demographic data of all the participants will be recorded. Each participant will be assessed for urine leakage, PFS, QoL, SF, and MH at baseline and subsequently, at four, eight and 12 weeks of intervention. Demographic parameters will be summarized using descriptive statistics. Continuous data will be computed for differences using inferential statistic of Analysis of variance, t-test and Man Whitney U as appropriate. All analyses will be performed using SPSS version 22.0 with probability set at 0.05 alpha level. DISCUSSION It is hoped that the outcome of this study will determine the effect of the Paula exercise method on urine leakage, pelvic floor strength, quality of life, sexual function, and mental health among women with post-fistula-repair incontinence and also provide evidence for the use of the Paula method in urinary incontinence. TRIAL REGISTRATION Pan African Clinical Trials Registry ( www.pactr.org ), identifier PACTR201906515532827.
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Affiliation(s)
- Saratu Umar Aliyu
- Department of Physiotherapy, Rasheed Shekoni Teaching Hospital, Dutse, Jigawa State, Nigeria.,Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Shmaila M Hanif
- Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, England
| | - Isa Usman Lawal
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria.
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18
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Safety and efficacy of trigonal BTX-A injections for children with neurological detrusor overactivity secondary to spinal cord injury. J Pediatr Surg 2020; 55:2736-2739. [PMID: 32571538 DOI: 10.1016/j.jpedsurg.2020.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of trigonal botulinum toxin A (BTX-A) injections for children with neurological detrusor overactivity (NDO) secondary to spinal cord injury (SCI). METHODS From February 2012 to December 2018, children with NDO secondary to SCI were enrolled. All patients received 200U BTX-A intradetrusor injections including the trigone. Videourodynamic study was performed at baseline and 12 weeks after injection. The primary outcome measures were the presence of vesicoureteral reflux and standardized urodynamic measures. Secondary outcomes included incontinence quality of life questionnaire (I-QoL), voiding volume, urinary incontinence episodes, and complete dryness. RESULTS A total of 33 pediatric inpatients (28 male and 5 female) completed the study. No one developed VUR at week 0 or week 12. At the first instance of NDO, maximum detrusor pressure (PdetmaxFNDO) and NDO duration were reduced by 29.8% and 31.8%, respectively, whereas NDO volume (VFNDO) increased by 50.5%,12 weeks after injection. Mean urinary incontinence episodes were reduced by 31.7%, whereas voiding volume and I-QOL were increased by 52.9% and 23.3%. 3 patients reported mild transient hematuria during the first week after injection. CONCLUSIONS Our results suggest that the use of bladder-trigone-including intradetrusor BTX-A injection does not induce VUR, and is safe and effective in children with NDO secondary to SCI. TYPE OF STUDY A prospective self-controlled trial LEVEL OF EVIDENCE: Level II.
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19
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Huber JP, Sawaki L. Dynamic body-weight support to boost rehabilitation outcomes in patients with non-traumatic spinal cord injury: an observational study. J Neuroeng Rehabil 2020; 17:157. [PMID: 33256797 PMCID: PMC7706039 DOI: 10.1186/s12984-020-00791-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background Dynamic body-weight support (DBWS) may play an important role in rehabilitation outcomes, but the potential benefit among disease-specific populations is unclear. In this study, we hypothesize that overground therapy with DBWS during inpatient rehabilitation yields greater functional improvement than standard-of-care in adults with non-traumatic spinal cord injury (NT-SCI). Methods This retrospective cohort study included individuals diagnosed with NT-SCI and undergoing inpatient rehabilitation. All participants were recruited at a freestanding inpatient rehabilitation hospital. Individuals who trained with DBWS for at least three sessions were allocated to the experimental group. Participants in the historical control group received standard-of-care (i.e., no DBWS). The primary outcome was change in the Functional Independence Measure scores (FIMgain). Results During an inpatient rehabilitation course, participants in the experimental group (n = 11), achieved a mean (SD) FIMgain of 48 (11) points. For the historical control group (n = 11), participants achieved a mean (SD) FIMgain of 36 (12) points. From admission to discharge, both groups demonstrated a statistically significant FIMgain. Between groups analysis revealed no significant difference in FIMgain (p = 0.022; 95% CI 2.0–22) after a post hoc correction for multiple comparisons. In a secondary subscore analysis, the experimental group achieved significantly higher gains in sphincter control (p = 0.011: 95% CI 0.83–5.72) with a large effect size (Cohen’s d 1.19). Locomotion subscores were not significantly different (p = 0.026; 95% CI 0.37–5.3) nor were the remaining subscores in self-care, mobility, cognition, and social cognition. Conclusions This is the first study to explore the impact of overground therapy with DBWS on inpatient rehabilitation outcomes for persons with NT-SCI. Overground therapy with DBWS appears to significantly improve functional gains in sphincter control compared to the standard-of-care. Gains achieved in locomotion, mobility, cognition, and social cognition did not meet significance. Findings from the present study will benefit from future large prospective and randomized studies.
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Affiliation(s)
- Justin P Huber
- Department of Physical Medicine and Rehabilitation, University of Kentucky, 2050 Versailles Road, Lexington, KY, 40504, USA.,Department of Mechanical Engineering, University of Kentucky, 2050 Versailles Road, Lexington, KY, 40504, USA
| | - Lumy Sawaki
- Department of Physical Medicine and Rehabilitation, University of Kentucky, 2050 Versailles Road, Lexington, KY, 40504, USA. .,Department of Neurology, University of Kentucky, 2050 Versailles Road, Lexington, KY, 40504, USA.
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20
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Finazzi Agrò E, Bianchi D, Iacovelli V. Pitfalls in Urodynamics. Eur Urol Focus 2020; 6:820-822. [PMID: 31982363 DOI: 10.1016/j.euf.2020.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/22/2019] [Accepted: 01/16/2020] [Indexed: 11/16/2022]
Abstract
Although urodynamics (UDS) is essential for the diagnosis and treatment of neurogenic lower urinary tract dysfunction, several possible pitfalls can be identified. In this paper we identify pitfalls in UDS and highlight limiting factors. UDS pitfalls that depend on the patient, on the physician, or on the test itself are described and analyzed. PATIENT SUMMARY: In this report we looked into pitfalls of urodynamics. Urodynamics is an essential tool in the diagnosis and treatment of neurogenic lower urinary tract dysfunction and always requires standardization and quality control to limit possible pitfalls.
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Affiliation(s)
- Enrico Finazzi Agrò
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | | | - Valerio Iacovelli
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy; Ospedale San Carlo di Nancy, Rome, Italy
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21
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Hagovska M, Svihra J, Breza J, Dubravicky J, Vargovcak M. A randomized, intervention parallel multicentre study to evaluate duloxetine and innovative pelvic floor muscle training in women with uncomplicated stress urinary incontinence-the DULOXING study. Int Urogynecol J 2020; 32:193-201. [PMID: 32852574 DOI: 10.1007/s00192-020-04516-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/21/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of our study was to evaluate the effect of a combination of innovative pelvic floor muscle training (iPFMT) and duloxetine compared with the use of duloxetine alone on women with stress urinary incontinence (SUI) after 12 weeks of treatment. METHODS We conducted a parallel multicentre study with randomized intervention in 45 national urological outpatient clinics. Patients with an enrolment ratio of 1:1 were divided into the experimental and control groups. The following were used for evaluation: incontinence episode frequency (IEF)/week, the International Consultation on Incontinence Questionnaire (ICIQ-SF), the Urinary Incontinence Quality of Life Scale (I-QoL) and the Patient Global Impression of Improvement (PGI-I). The experimental group received oral treatment with duloxetine (a daily dose of 40 mg BID) and innovative pelvic floor muscle training (iPFMT). The control group received only oral treatment with duloxetine at a daily dose of 40 mg BID. RESULTS The number of women who were evaluated was 158. The control group comprised 79 women with an average age of 56.8 ± 13.8 years and the experimental group comprised 79 women with an average age of 53.4 ± 11.9 years. There were no significant differences in pre-treatment parameters. For the intent-to-treat analysis after 12 weeks' treatment, significant differences were observed between the experimental vs. control group (p < 0.001) for the following variables: IEF/week decrease (66.7% vs. 50.0%); ICIQ-UI SF decrease (8.3 ± 3.8 vs. 9.7 ± 4.2); PGI-I (70.8% vs. 65.6%); I-QoL score increase (19.3% vs. 6.6%). CONCLUSION The addition of iPFMT to duloxetine treatment improves SUI syndrome in women compared with duloxetine treatment alone. REGISTRATION Clinical Trials.gov NCT04140253.
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Affiliation(s)
- Magdalena Hagovska
- Department of Physiatry, Balneology, and Medical Rehabilitation, Institution-Faculty of Medicine, PJ Safarik University, Kosice, Slovak Republic
| | - Jan Svihra
- Department of Urology, Institution-Jessenius Faculty of Medicine, Martin, Comenius University Bratislava, Bratislava, Slovak Republic.
| | - Jan Breza
- National Institute of Pediatric Diseases, Department of Pediatric Urology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovak Republic
| | - Jozef Dubravicky
- Department of Urology, University Hospital Bratislava, Bratislava, Slovak Republic
| | - Marek Vargovcak
- Outpatient Clinic of Urology, Railway Hospital, Kosice, Slovak Republic
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Otmani N, Epstein J, Benaicha N, Alaoui AC, Kinany KE, Atassi M, Qarmiche N, Tachfouti N, Guillemin F, Fakir SE. Cross-cultural adaptation and validation of the Moroccan version of the incontinence quality of life questionnaire (I-QoL) in urinary incontinence patients. J Gynecol Obstet Hum Reprod 2020; 49:101830. [PMID: 32534216 DOI: 10.1016/j.jogoh.2020.101830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Because of the importance and prevalence of incontinence in women, there is growing interest in the development and use of well-designed quality of life questionnaires. The objective of this study is to adapt and validate, the I-QoL, a quality of life questionnaire, in Moroccan dialect, and to assess its psychometric properties in people suffering from urinary incontinence STUDY DESIGN: One hundred patients (77 % female) with a symptom of urinary incontinence participated in the study and filled out the Moroccan version of the questionnaire. The reliability and validity of the questionnaire were assessed by Cronbach's alpha coefficient (α), the intraclass correlation coefficient (ICC), and confirmatory factor analysis. RESULTS The results showed that the Moroccan version of the I-QOL has very good psychometric properties. The overall I-QoL summary score and subscales showed high internal consistency (alpha ranging from 0.94 to 0.99). Inter-rater reliability was substantial for the three subscales and the total score. The ICC, assessing reproducibility at two weeks, ranged from 0.89 to 0.99, demonstrating the stability of the scores. The I-QOL was able to discriminate between different levels of self- perceived severity. Significant differences in I-QOL scores (p<0.001) were observed when comparing I-QOL scores by the number of incontinence-related medical visits made by patients during the past year. CONCLUSION The Moroccan version of the I-QOL is a valid and reliable tool to determine the influence of urinary incontinence on health-related quality of life in Moroccan persons.
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Affiliation(s)
- Nada Otmani
- Epidemiology, Clinical Research and Community Health Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
| | | | - Nadia Benaicha
- Epidemiology, Clinical Research and Community Health Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Amina Chrifi Alaoui
- Epidemiology, Clinical Research and Community Health Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Khaoula El Kinany
- Epidemiology, Clinical Research and Community Health Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mariam Atassi
- Epidemiology, Clinical Research and Community Health Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Noura Qarmiche
- Epidemiology, Clinical Research and Community Health Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Nabil Tachfouti
- Epidemiology, Clinical Research and Community Health Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | | | - Samira El Fakir
- Epidemiology, Clinical Research and Community Health Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Quality of Life in Neurourology Patients. Eur Urol Focus 2020; 6:531-533. [DOI: 10.1016/j.euf.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/20/2019] [Accepted: 09/03/2019] [Indexed: 11/20/2022]
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Hagovska M, Svihra J. Evaluation of duloxetine and innovative pelvic floor muscle training in women with stress urinary incontinence (DULOXING): Study protocol clinical trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e18834. [PMID: 32028393 PMCID: PMC7015553 DOI: 10.1097/md.0000000000018834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION There is a lack of published studies about the combination of duloxetine and pelvic floor muscle training (PFMT) in women with stress urinary incontinence (SUI). The aim of our work will be to evaluate the effect of this intervention by assessing whether there is a change in the incontinence episode frequency (IEF), Incontinence Quality of Life (I-QoL), Patient Global Impression of Improvement score (PGI-I) and mean time between voids (MTBV). Combined therapy with duloxetine and PFMT will be compared to duloxetine treatment alone with respect to its efficacy and side effects. METHODS This study will be a randomized intervention, parallel, multicenter study in collaboration with 45 urological outpatient clinics at the national level. Patients will be assigned in a 1:1 ratio to the experimental and control groups using simple randomization according to odd and even numbers assigned sequentially to the patients at each clinic. The experimental intervention will be 12 weeks. The experimental group will receive oral treatment with duloxetine at a daily dose of 2 × 40 mg and will be required to perform innovative PFMT. The control group will receive the same oral duloxetine treatment (2 × 40 mg a day) but will not perform PMFT. Data will be collected from both groups before intervention and after the 12-week intervention is completed. DISCUSSION The study protocol presents the starting points, design and randomization of an interventional multicenter study to monitor the effect of the combination of duloxetine with innovative PFMT compared to duloxetine treatment alone in women with SUI. This study may provide evidence of the efficacy of this combined treatment for SUI and highlight benefits associated with active approaches to treatment through exercise. REGISTRATION This study was retrospectively registered in the ClinicalTrials.go NCT04140253. Protocol version 1.0. date 11.1.2019.
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Affiliation(s)
- Magdalena Hagovska
- Department of Physiatry, Balneology, and Medical Rehabilitation, Institution - Faculty of Medicine, PJ Safarik University, Kosice
| | - Jan Svihra
- Department of Urology, Institution - Jessenius Faculty of Medicine, Martin, Comenius University Bratislava, Slovak Republic
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Averbeck MA, Iacovelli V, Panicker J, Schurch B, Finazzi Agrò E. Urodynamics in patients with multiple sclerosis: A consensus statement from a urodynamic experts working group. Neurourol Urodyn 2019; 39:73-82. [PMID: 31746485 DOI: 10.1002/nau.24230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 11/12/2022]
Abstract
AIMS Urodynamics (UDS) is often indicated for multiple sclerosis (MS) patients either at presentation to specialized medical centers or after failure of conservative management of lower urinary tract dysfunction (LUTD). However, the ideal moment and context to indicate this exam in this group of patients remain controversial. We aimed to establish a consensus panel to address the role of UDS in MS patients. METHODS A panel representing urology, rehabilitation medicine, and neurology skilled in neuro-urology participated in a consensus-forming project using a Delphi method to reach consensus on the role of UDS in MS patients. RESULTS In total, five experts participated. All panelists participated in the four phases of the consensus process. Consensus was reached if ≥70% of the experts agreed on recommendations. To facilitate a common understanding among all experts, a face-to-face consensus meeting was held in Florence in September 2017 and then with a follow-up teleconference in March 2018. By the end of the Delphi process, formal consensus was achieved for 100% of the items and an algorithm was then developed in a face-to-face meeting in Philadelphia in August 2018. The final expert opinion recommendations were approved by the unanimous consensus of the panel. CONCLUSIONS UDS represents an important diagnostic tool for MS patients and is particularly useful to evaluate the pattern of LUT dysfunction in high-risk patients. There is a lack of high-evidence level studies to support an optimal urodynamic long-term follow-up protocol.
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Affiliation(s)
- M A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - V Iacovelli
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy.,Urology Unit, San Carlo di Nancy General Hospital - GVM Care and Research, Rome, Italy
| | - J Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, London, UK
| | - B Schurch
- Neurourology Unit, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
| | - E Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
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Gabay B, Maucort-Boulch D, Ruffion A, Scheiber Nogueira MC, Terrier JE. [Long-term outcomes of intradetrusor botulinum toxin A in multiple sclerosis patients]. Prog Urol 2019; 29:156-165. [PMID: 30880066 DOI: 10.1016/j.purol.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/24/2018] [Accepted: 02/01/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of this study was to analyze the long-term efficiency and tolerance of TB in the management of anticholinergic refractory hyperactive bladder in patients with MS. MATERIAL AND METHOD Retrospective mono-centric cohort study of all patients with MS who had a TB injection for anticholinergic refractory hyperactivity from 2005 to 2015. The primary endpoint was clinical efficiency based on the frequency of urinary leakage and symptomatic urinary tract infections. RESULTS One hundred and nineteen patients received the first injection. Median follow-up was 26.5 months. After an injection, there was a significant decrease in the number of leaks, with 69.7% of patients without leaks and 93.3% of patients without urinary tract infections. After 7 injections 44% of the patients were still dry and 62.07% had no symptomatic urinary tract infections. The failure rate was 24.37%, the average duration before discharge was 34.7 months. 19 (66%) patients stop treatment for loss of efficacy, 9 (31%) for disease progression and 1 (3%) for cessation of treatment without cause. Of the 774 injections performed, there were complications for 26 of them (3.35%). CONCLUSION Botulinum toxin remains the second-line reference treatment for detrusor overactivity of neurological origin. There is, at least in the short term, a good answer in a large number of cases. This response can be maintained for many years, especially if patients use intermittent catheterization, with excellent tolerance. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- B Gabay
- Service d'urologie, centre hospitalier Lyon Sud, hospices civils de Lyon, 69310 Pierre Bénites, France; Université Claude-Bernard-Lyon 1, 69000 Lyon, France.
| | - D Maucort-Boulch
- Université Claude-Bernard-Lyon 1, 69000 Lyon, France; Service de biostatistique et bioinformatique, hospices civils de Lyon, 69003 Lyon, France.
| | - A Ruffion
- Service d'urologie, centre hospitalier Lyon Sud, hospices civils de Lyon, 69310 Pierre Bénites, France; Université Claude-Bernard-Lyon 1, 69000 Lyon, France.
| | | | - J E Terrier
- Service d'urologie, centre hospitalier Lyon Sud, hospices civils de Lyon, 69310 Pierre Bénites, France; Université Claude-Bernard-Lyon 1, 69000 Lyon, France.
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Efficacy and Safety of OnabotulinumtoxinA in Patients With Neurogenic Detrusor Overactivity Caused by Spinal Cord Injury: A Systematic Review and Meta-analysis. Int Neurourol J 2018; 22:275-286. [PMID: 30599499 PMCID: PMC6312972 DOI: 10.5213/inj.1836118.059] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/25/2018] [Indexed: 01/10/2023] Open
Abstract
Purpose OnabotulinumtoxinA (BoNT-A) is a promising therapy for treating neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury (SCI). This systematic review and meta-analysis aimed to carry out an in-depth review and to make an objective estimation of the efficacy and safety of BoNT-A on NDO after SCI. Methods The PubMed, Embase, and Cochrane databases were searched for all relevant articles published from 2001 to 2016 that referred to NDO, SCI, and BoNT-A or botulinum toxin A. All data were recorded in an Excel spreadsheet by 2 individual reviewers. Review Manager version 5.3 was used to carry out the meta-analysis. Results This analysis included 17 studies involving 1,455 patients. Compared with placebo and baseline, BoNT-A was effective in increasing maximum cystometric capacity, volume at first involuntary detrusor contraction, cystometric bladder capacity (all P<0.00001), compliance (P=0.001), and the number of patients with complete dryness (P=0.0003), and decreasing detrusor pressure, the number of patients with no involuntary detrusor contractions, the maximum flow rate, the incidence of detrusor overactivity (all P<0.00001), and the number of urinary incontinence episodes (P=0.001). There were no statistically significant differences between doses of 200 U and 300 U or between injections into the detrusor and submucosa. There were no life-threatening adverse events. Conclusions BoNT-A is effective and safe in treating NDO after SCI. There were no statistically significant differences between doses of 200 U and 300 U or between injecting into the detrusor and submucosa. However, more high-quality randomized controlled trials are still needed.
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Myers JB, Lenherr SM, Stoffel JT, Elliott SP, Presson AP, Zhang C, Rosenbluth J, Jha A, Patel D, Welk B. The effects of augmentation cystoplasty and botulinum toxin injection on patient-reported bladder function and quality of life among individuals with spinal cord injury performing clean intermittent catheterization. Neurourol Urodyn 2018; 38:285-294. [DOI: 10.1002/nau.23849] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/10/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Jeremy B. Myers
- Department of Surgery (Urology); University of Utah; Salt Lake City Utah
| | - Sara M. Lenherr
- Department of Surgery (Urology); University of Utah; Salt Lake City Utah
| | - John T. Stoffel
- Department of Urology; University of Michigan; Ann Arbor Michigan
| | - Sean P. Elliott
- Department of Urology; University of Minnesota; Minneapolis Minnesota
| | - Angela P. Presson
- Department of Internal Medicine; University of Utah Division of Epidemiology and Biostatistics; Salt Lake City Utah
| | - Chong Zhang
- Department of Internal Medicine; University of Utah Division of Epidemiology and Biostatistics; Salt Lake City Utah
| | - Jeffery Rosenbluth
- Department of Physical Medicine and Rehabilitation; University of Utah; Salt Lake City Utah
| | - Amitabh Jha
- Department of Physical Medicine and Rehabilitation; Salt Lake City Veterans Medical Center; Salt Lake City Utah
| | - DarshanP Patel
- Department of Surgery (Urology); University of Utah; Salt Lake City Utah
| | - Blayne Welk
- Department of Surgery; University of Western Ontario; London Ontario Canada
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The impact of physical activity measured by the International Physical Activity questionnaire on the prevalence of stress urinary incontinence in young women. Eur J Obstet Gynecol Reprod Biol 2018; 228:308-312. [DOI: 10.1016/j.ejogrb.2018.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 11/24/2022]
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Krhut J, Borovička V, Bílková K, Sýkora R, Míka D, Mokriš J, Zachoval R. Efficacy and safety of mirabegron for the treatment of neurogenic detrusor overactivity-Prospective, randomized, double-blind, placebo-controlled study. Neurourol Urodyn 2018; 37:2226-2233. [PMID: 29603781 DOI: 10.1002/nau.23566] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/05/2018] [Indexed: 11/11/2022]
Abstract
AIMS To assess the efficacy and safety of mirabegron in the treatment of neurogenic detrusor overactivity. METHODS This prospective, multicenter, randomized, double-blind, placebo-controlled study was conducted in three tertiary centers, and included 78 patients suffering from spinal cord injury or multiple sclerosis. Patients were randomized for Mirabegron 50 mg (Group A) or placebo (Group B). Urodynamic parameters, the 24 h pad-weight test, and patient-reported outcomes were assessed. Safety assessments included monitoring the incidence and severity of adverse events. Changes in time and differences between groups were assessed with nonparametric Kruskal-Wallis one-way analysis of variance; P ≤ 0.05 was considered statistically significant. RESULTS In total, 66 patients were eligible for inclusion in the final analysis. There was a significant increase of volume at the first detrusor contraction (P = 0.00047) and an improvement in bladder compliance (P = 0.0041) in the mirabegron group compared with the placebo-treated group, whereas the increase in cystometric capacity did not reach statistical significance (P = 0.061). There was a clear tendency to reduced urine leakage (P = 0.056) in Group A. There were significant changes in all the patient-reported outcomes, favoring the mirabegron group. The incidence of drug-related adverse events was 3.13%. CONCLUSIONS Mirabegron (50 mg) improved both urodynamic variables and patient-reported outcomes in patients with NDO. The treatment was tolerated well.
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Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | | | - Karolína Bílková
- Spinal Cord Rehabilitation Unit, Rehabilitation Center, Kladruby, Czech Republic
| | - Radek Sýkora
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | - David Míka
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | - Jan Mokriš
- Department of Urology, Thomayer Hospital, Prague, Czech Republic
| | - Roman Zachoval
- Department of Urology, Thomayer Hospital, Prague, Czech Republic
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Welk B, Hickling D, McKibbon M, Radomski S, Ethans K. A pilot randomized-controlled trial of the urodynamic efficacy of mirabegron for patients with neurogenic lower urinary tract dysfunction. Neurourol Urodyn 2018; 37:2810-2817. [PMID: 30168626 DOI: 10.1002/nau.23774] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 06/18/2018] [Indexed: 12/28/2022]
Abstract
AIMS To determine the effectiveness of mirabegron in patients with neurogenic lower urinary tract dysfunction. METHODS Randomized, double-blind, placebo-controlled study. Canadian patients with spinal cord injury (SCI) or multiple sclerosis (MS) with urinary symptoms and incontinence were recruited. Patients were randomized to mirabegron 25 mg (or an identical placebo) for 2 weeks at which point a dose escalation to mirabegron 50 mg (or an identical placebo) was maintained for 8 weeks. Urodynamics were performed before and after treatment. The primary outcome measure was maximum cystometric capacity (MCC). Intention to treat analysis and ANCOVA models (with adjustment for baseline values) were used and marginal means (MM) are reported; P-value <0.05 was considered significant. RESULTS Sixteen (9 SCI and 7 MS) patients were randomized to mirabegron and 16 (10 SCI and 6 MS) to placebo. At study completion, there was no significant difference in MCC between mirabegron and placebo (MM 305 vs 369 mL, P = 0.20). There was no significant difference in volume at first neurogenic detrusor overactivity (NDO, MM 167 vs 137 mL, P = 0.14) and peak pressure of NDO (MM 69 vs 82 cmH2 O, P = 0.25). There was no significant difference in pad weights or voiding diary parameters. There was a significantly lower symptom burden among those treated with mirabegron (total neurogenic bladder symptom score MM 29 vs 34, P = 0.047). CONCLUSIONS Among patients with SCI or MS, we demonstrated non-significant trends towards improvement in some urodynamic parameters with mirabegron 50 mg compared to placebo, and a significantly lower neurogenic bladder symptom burden.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Duane Hickling
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Sidney Radomski
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen Ethans
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Tullman M, Chartier-Kastler E, Kohan A, Keppenne V, Brucker BM, Egerdie B, Mandle M, Nicandro JP, Jenkins B, Denys P. Low-dose onabotulinumtoxinA improves urinary symptoms in noncatheterizing patients with MS. Neurology 2018; 91:e657-e665. [PMID: 30030330 PMCID: PMC6105039 DOI: 10.1212/wnl.0000000000005991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 05/14/2018] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the efficacy and safety of onabotulinumtoxinA 100 U in noncatheterizing patients with multiple sclerosis (MS) with urinary incontinence (UI) due to neurogenic detrusor overactivity (NDO). Methods In this randomized, double-blind phase III study, patients received onabotulinumtoxinA 100 U (n = 66) or placebo (n = 78) as intradetrusor injections via cystoscopy. Assessments included changes from baseline in urinary symptoms, urodynamics, and Incontinence–Quality of Life (I-QOL) total score. Adverse events (AEs) were assessed, including initiation of clean intermittent catheterization (CIC) due to urinary retention. Results OnabotulinumtoxinA vs placebo significantly reduced UI at week 6 (−3.3 episodes/day vs −1.1 episodes/day, p < 0.001; primary endpoint). Significantly greater proportions of onabotulinumtoxinA-treated patients achieved 100% UI reduction (53.0% vs 10.3%, p < 0.001). Significant improvements in urodynamics (p < 0.01) were observed with onabotulinumtoxinA. Improvements in I-QOL score were significantly greater with onabotulinumtoxinA (40.4 vs 9.9, p < 0.001) and ≈3 times the minimally important difference (+11 points). The most common AE was urinary tract infection (25.8%). CIC rates were 15.2% for onabotulinumtoxinA and 2.6% for placebo. Conclusion In noncatheterizing patients with MS, onabotulinumtoxinA 100 U significantly improved UI and quality of life with lower CIC rates than previously reported with onabotulinumtoxinA 200 U. ClinicalTrials.gov identifier: NCT01600716. Classification of evidence This study provides Class I evidence that compared with placebo, 100 U onabotulinumtoxinA intradetrusor injections significantly reduce UI and improve quality of life in noncatheterizing patients with MS and NDO.
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Affiliation(s)
- Mark Tullman
- From the MS Center for Innovations in Care (M.T.), St. Louis, MO; Sorbonne Universités (E.C.-K.), UPMC Paris 6, Pitié Salpétrière Academic Hospital, AP-HP, Paris, UMR Inserm 1179, France; Advanced Urology Centers (A.K.), Bethpage, NY; Université de Liège (V.K.), Belgium; New York University Langone Medical Center (B.M.B), New York; Urology Associates/Urologic Medical Research (B.E.), Kitchener, Ontario, Canada; Evidence Scientific Solutions (M.M.), Philadelphia, PA; Allergan plc (J.P.N., B.J.), Irvine, CA; and Hôpital Raymond Poincaré (P.D.), Garches, UVSQ, UMR Inserm 1179, France.
| | - Emmanuel Chartier-Kastler
- From the MS Center for Innovations in Care (M.T.), St. Louis, MO; Sorbonne Universités (E.C.-K.), UPMC Paris 6, Pitié Salpétrière Academic Hospital, AP-HP, Paris, UMR Inserm 1179, France; Advanced Urology Centers (A.K.), Bethpage, NY; Université de Liège (V.K.), Belgium; New York University Langone Medical Center (B.M.B), New York; Urology Associates/Urologic Medical Research (B.E.), Kitchener, Ontario, Canada; Evidence Scientific Solutions (M.M.), Philadelphia, PA; Allergan plc (J.P.N., B.J.), Irvine, CA; and Hôpital Raymond Poincaré (P.D.), Garches, UVSQ, UMR Inserm 1179, France
| | - Alfred Kohan
- From the MS Center for Innovations in Care (M.T.), St. Louis, MO; Sorbonne Universités (E.C.-K.), UPMC Paris 6, Pitié Salpétrière Academic Hospital, AP-HP, Paris, UMR Inserm 1179, France; Advanced Urology Centers (A.K.), Bethpage, NY; Université de Liège (V.K.), Belgium; New York University Langone Medical Center (B.M.B), New York; Urology Associates/Urologic Medical Research (B.E.), Kitchener, Ontario, Canada; Evidence Scientific Solutions (M.M.), Philadelphia, PA; Allergan plc (J.P.N., B.J.), Irvine, CA; and Hôpital Raymond Poincaré (P.D.), Garches, UVSQ, UMR Inserm 1179, France
| | - Veronique Keppenne
- From the MS Center for Innovations in Care (M.T.), St. Louis, MO; Sorbonne Universités (E.C.-K.), UPMC Paris 6, Pitié Salpétrière Academic Hospital, AP-HP, Paris, UMR Inserm 1179, France; Advanced Urology Centers (A.K.), Bethpage, NY; Université de Liège (V.K.), Belgium; New York University Langone Medical Center (B.M.B), New York; Urology Associates/Urologic Medical Research (B.E.), Kitchener, Ontario, Canada; Evidence Scientific Solutions (M.M.), Philadelphia, PA; Allergan plc (J.P.N., B.J.), Irvine, CA; and Hôpital Raymond Poincaré (P.D.), Garches, UVSQ, UMR Inserm 1179, France
| | - Benjamin M Brucker
- From the MS Center for Innovations in Care (M.T.), St. Louis, MO; Sorbonne Universités (E.C.-K.), UPMC Paris 6, Pitié Salpétrière Academic Hospital, AP-HP, Paris, UMR Inserm 1179, France; Advanced Urology Centers (A.K.), Bethpage, NY; Université de Liège (V.K.), Belgium; New York University Langone Medical Center (B.M.B), New York; Urology Associates/Urologic Medical Research (B.E.), Kitchener, Ontario, Canada; Evidence Scientific Solutions (M.M.), Philadelphia, PA; Allergan plc (J.P.N., B.J.), Irvine, CA; and Hôpital Raymond Poincaré (P.D.), Garches, UVSQ, UMR Inserm 1179, France
| | - Blair Egerdie
- From the MS Center for Innovations in Care (M.T.), St. Louis, MO; Sorbonne Universités (E.C.-K.), UPMC Paris 6, Pitié Salpétrière Academic Hospital, AP-HP, Paris, UMR Inserm 1179, France; Advanced Urology Centers (A.K.), Bethpage, NY; Université de Liège (V.K.), Belgium; New York University Langone Medical Center (B.M.B), New York; Urology Associates/Urologic Medical Research (B.E.), Kitchener, Ontario, Canada; Evidence Scientific Solutions (M.M.), Philadelphia, PA; Allergan plc (J.P.N., B.J.), Irvine, CA; and Hôpital Raymond Poincaré (P.D.), Garches, UVSQ, UMR Inserm 1179, France
| | - Meryl Mandle
- From the MS Center for Innovations in Care (M.T.), St. Louis, MO; Sorbonne Universités (E.C.-K.), UPMC Paris 6, Pitié Salpétrière Academic Hospital, AP-HP, Paris, UMR Inserm 1179, France; Advanced Urology Centers (A.K.), Bethpage, NY; Université de Liège (V.K.), Belgium; New York University Langone Medical Center (B.M.B), New York; Urology Associates/Urologic Medical Research (B.E.), Kitchener, Ontario, Canada; Evidence Scientific Solutions (M.M.), Philadelphia, PA; Allergan plc (J.P.N., B.J.), Irvine, CA; and Hôpital Raymond Poincaré (P.D.), Garches, UVSQ, UMR Inserm 1179, France
| | - Jean Paul Nicandro
- From the MS Center for Innovations in Care (M.T.), St. Louis, MO; Sorbonne Universités (E.C.-K.), UPMC Paris 6, Pitié Salpétrière Academic Hospital, AP-HP, Paris, UMR Inserm 1179, France; Advanced Urology Centers (A.K.), Bethpage, NY; Université de Liège (V.K.), Belgium; New York University Langone Medical Center (B.M.B), New York; Urology Associates/Urologic Medical Research (B.E.), Kitchener, Ontario, Canada; Evidence Scientific Solutions (M.M.), Philadelphia, PA; Allergan plc (J.P.N., B.J.), Irvine, CA; and Hôpital Raymond Poincaré (P.D.), Garches, UVSQ, UMR Inserm 1179, France
| | - Brenda Jenkins
- From the MS Center for Innovations in Care (M.T.), St. Louis, MO; Sorbonne Universités (E.C.-K.), UPMC Paris 6, Pitié Salpétrière Academic Hospital, AP-HP, Paris, UMR Inserm 1179, France; Advanced Urology Centers (A.K.), Bethpage, NY; Université de Liège (V.K.), Belgium; New York University Langone Medical Center (B.M.B), New York; Urology Associates/Urologic Medical Research (B.E.), Kitchener, Ontario, Canada; Evidence Scientific Solutions (M.M.), Philadelphia, PA; Allergan plc (J.P.N., B.J.), Irvine, CA; and Hôpital Raymond Poincaré (P.D.), Garches, UVSQ, UMR Inserm 1179, France
| | - Pierre Denys
- From the MS Center for Innovations in Care (M.T.), St. Louis, MO; Sorbonne Universités (E.C.-K.), UPMC Paris 6, Pitié Salpétrière Academic Hospital, AP-HP, Paris, UMR Inserm 1179, France; Advanced Urology Centers (A.K.), Bethpage, NY; Université de Liège (V.K.), Belgium; New York University Langone Medical Center (B.M.B), New York; Urology Associates/Urologic Medical Research (B.E.), Kitchener, Ontario, Canada; Evidence Scientific Solutions (M.M.), Philadelphia, PA; Allergan plc (J.P.N., B.J.), Irvine, CA; and Hôpital Raymond Poincaré (P.D.), Garches, UVSQ, UMR Inserm 1179, France
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Quality of Life and the Neurogenic Bladder: Does Bladder Management Technique Matter? CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0443-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Welk B, Lenherr S, Elliott S, Stoffel J, Presson AP, Zhang C, Myers JB. The Neurogenic Bladder Symptom Score (NBSS): a secondary assessment of its validity, reliability among people with a spinal cord injury. Spinal Cord 2017; 56:259-264. [DOI: 10.1038/s41393-017-0028-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/27/2017] [Accepted: 09/30/2017] [Indexed: 01/07/2023]
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Lloyd SM, Crawford G, McSkimming P, Grifi M, Greenwell TJ, Ockrim JL. The impact of age, gender and severity of overactive bladder wet on quality of life, productivity, treatment patterns and satisfaction. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817710111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective: The objective of this article is to determine the impact of idiopathic overactive bladder wet (OAB wet) severity, age and gender on health-related quality of life (HRQoL), productivity, treatment patterns and treatment satisfaction. Materials and methods: A prospective, cross-sectional online survey of adults in the United Kingdom was performed to screen for self-reported symptoms of OAB wet. Respondents completed the King’s Health Questionnaire or the Incontinence Quality of Life, as well as the Euroqol 5D, and the Work Productivity and Activity Impairment Specific Health Problem questionnaire, and questions pertaining to distress, treatment and treatment satisfaction. Results: A total of 249 of 1126 respondents (22.1%) met the criteria for OAB wet. Respondents with moderate/severe OAB wet and all women experienced significantly worse HRQoL and work productivity than those with mild symptoms and all men, respectively. Among all OAB wet responders, 62.7% were receiving treatment for their condition, predominantly pads (40.2%); only 1.6% were receiving specialised treatment. Nearly one-half (44.6%) were somewhat or completely dissatisfied with their current treatment. Conclusion: In individuals with OAB wet, severity and gender negatively impact HRQoL and work productivity. A substantial proportion of OAB wet individuals were untreated, and low treatment satisfaction was reported in those receiving treatment. Treatment was generally conservative.
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Affiliation(s)
- SM Lloyd
- Robertson Centre for Biostatistics, University of Glasgow, UK
| | | | - P McSkimming
- Robertson Centre for Biostatistics, University of Glasgow, UK
| | - M Grifi
- Reimbursement and Health Economics, Medtronic International Trading Sàrl, Switzerland
| | - TJ Greenwell
- Institute of Urology, University College Hospital London, UK
| | - JL Ockrim
- Institute of Urology, University College Hospital London, UK
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Best KL, Ethans K, Craven BC, Noreau L, Hitzig SL. Identifying and classifying quality of life tools for neurogenic bladder function after spinal cord injury: A systematic review. J Spinal Cord Med 2017; 40:505-529. [PMID: 27734771 PMCID: PMC5815152 DOI: 10.1080/10790268.2016.1226700] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To identify and classify quality of life (QoL) tools for assessing the influence of neurogenic bladder after spinal cord injury/disease (SCI). DESIGN Systematic Review Methods: Medline/Pubmed, CINAHL, and PsycInfo were searched using terms related to SCI, neurogenic bladder and QoL. Studies that assessed the influence neurogenic bladder on QoL (or related construct) in samples consisting of ≥50% individuals with SCI were included. Two independent reviewers screened titles and abstracts of 368 identified references; 118 full-text articles were assessed for eligibility, and 42 studies were included. Two reviewers independently classified outcomes as objective (societal viewpoint) or subjective (patient perspective) using a QoL framework. RESULTS Ten objective QoL measures were identified, with the Medical Outcomes Short Form (SF-36/SF-12) used most frequently. Fourteen subjective QoL measures were identified; 8 were specific to neurogenic bladder. Psychometric evidence for SCI-specific neurogenic bladder QoL tools was reported for the Quality of Life Index (QLI), Qualiveen, Bladder Complications Scale, Spinal Cord Injury-Quality of Life (SCI-QOL) Bladder Management Difficulties, and the SCI-QOL Bladder Management Difficulties-Short Form. The QLI and Qualiveen showed sensitivity to neurogenic bladder in experimental designs. CONCLUSION Several objective and subjective tools exist to assess the influence of neurogenic bladder on QoL in SCI. The QLI and Qualiveen, both subjective tools, were the only validated SCI-specific tools that showed sensitivity to neurogenic bladder. Further validation of existing subjective SCI-specific outcomes is needed. Research to validate objective measures of QoL would be useful for informing practice and policy related to resource allocation for bladder care post-SCI.
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Affiliation(s)
- Krista L. Best
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, Quebec City, QC, Canada,Correspondence to: Krista L. Best, Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Blvd Hamel, Québec, QC, G1M 2S8, Canada.
| | - Karen Ethans
- University of Manitoba, Department of Medicine, Winnipeg, MB, Canada,Health Sciences Centre, Section of Physical Medicine and Rehabilitation, Winnipeg, MB, Canada
| | - B. Catharine Craven
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Luc Noreau
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, Quebec City, QC, Canada
| | - Sander L. Hitzig
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,St-John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
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Patel DP, Myers JB, Lenherr SM. How to Measure Quality-of-Life Concerns in Patients with Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am 2017; 44:345-353. [DOI: 10.1016/j.ucl.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Schurch B, Iacovelli V, Averbeck MA, Carda S, Altaweel W, Finazzi Agrò E. Urodynamics in patients with spinal cord injury: A clinical review and best practice paper by a working group of The International Continence Society Urodynamics Committee. Neurourol Urodyn 2017; 37:581-591. [DOI: 10.1002/nau.23369] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/30/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Brigitte Schurch
- Department of Clinical Neurosciences; Neuropsychology and Neurorehabilitation Service; Vaudois University Hospital of Lausanne; Lausanne Switzerland
| | - Valerio Iacovelli
- Department of Experimental Medicine and Surgery; Unit of Functional Urology; Tor Vergata University Hospital; University of Rome Tor Vergata; Rome Italy
| | | | - Stefano Carda
- Department of Clinical Neurosciences; Neuropsychology and Neurorehabilitation Service; Vaudois University Hospital of Lausanne; Lausanne Switzerland
| | - Waleed Altaweel
- King Faisal Specialist Hospital and Research Centre; Alfaisal University; Riyadh Saudi Arabia
| | - Enrico Finazzi Agrò
- Department of Experimental Medicine and Surgery; Unit of Functional Urology; Tor Vergata University Hospital; University of Rome Tor Vergata; Rome Italy
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Walia P, Kaur J. Development and validation of Incontinence - Activity Participation Scale for spinal cord injury. Indian J Urol 2017; 33:159-164. [PMID: 28469306 PMCID: PMC5396406 DOI: 10.4103/0970-1591.203413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION We aimed to develop and validate an Incontinence - Activity Participation Scale (I-APS) for measurement of activity limitation and participation restriction due to bladder problems in spinal cord injury (SCI). MATERIALS AND METHODS The process of development was initiated by formation of open-ended questions after thorough review of literature which were then administered to SCI participants, caretakers, and professionals working with SCI. Items were generated based on their responses and initial draft of scale was formulated. This initial draft of the scale containing 77 items was then administered to 56 SCI participants for reduction of items using factor analysis, and a prefinal version of the scale was obtained containing thirty items only. Content validity and face validity was then established. RESULTS The I-APS is both health professional and self-administered questionnaire including two domains: Activities of daily living and occupation with 16 items having a content validity of 0.84. The overall internal consistency reliability was 0.86. CONCLUSION The I-APS is a valid, comprehensive instrument that measures the activity limitation and participation restrictions due to bladder problems in SCI.
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Affiliation(s)
- Priya Walia
- Indian Spinal Injuries Centre, New Delhi, India
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Denys P, Dmochowski R, Aliotta P, Castro-Diaz D, Blok B, Ethans K, Aboushwareb T, Magyar A, Kennelly M. Positive outcomes with first onabotulinumtoxinA treatment persist in the long term with repeat treatments in patients with neurogenic detrusor overactivity. BJU Int 2017; 119:926-932. [PMID: 28139068 DOI: 10.1111/bju.13795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To examine whether response to first treatment with onabotulinumtoxinA is predictive of long-term treatment outcome in patients with neurogenic detrusor overactivity (NDO). PATIENTS AND METHODS Patients with NDO who were enrolled in a 3-year extension study (after a 52-week phase III study) received onabotulinumtoxinA 'as needed', based on fulfilment of prespecified retreatment criteria. This post hoc analysis included patients who received only the 200-U dose during the phase III and extension studies. Data on mean percent reduction from baseline in urinary incontinence (UI) episodes at week 6 after the first treatment were analysed, and the patients were stratified into three response groups: <50% (group 1; n = 33), 50-74% (group 2; n = 23), and 75-100% (group 3; n = 139). The following were assessed: change from baseline in mean percent UI reduction; proportions of patients who achieved ≥50% and 100% UI reduction after each subsequent treatment, and patients who achieved ≥50% UI reduction after all subsequent treatments; change from baseline in Incontinence Quality of Life (I-QOL) total summary score; and the proportion of patients who achieved or exceeded the minimally important difference (MID; +11 points) in I-QOL score. Adverse events (AEs) were also assessed. RESULTS The majority of the patients (83.1%; 162/195) experienced a ≥50% UI reduction after onabotulinumtoxinA treatment 1. Baseline characteristics were largely similar across the groups. After treatment 1, the mean percent reduction in UI remained consistent in subsequent treatments 2-6 for patients in response group 2 (range: 64.5-83.5%) and group 3 (range: 79.4-88.0%), but increased for those in the low response group (range: 36.3-60.3%). After treatment 1, the proportion of patients who achieved ≥50% reduction in UI episodes was consistent with subsequent treatments 2-6 in group 2 (range: 75.0-100%) and group 3 (range: 87.3-97.1%), but increased in the low response group (range: 48.3-72.7%). Even among those who achieved a low response after treatment 1, 37.9% of patients achieved ≥50% UI reduction in all subsequent treatments. Improvements in I-QOL scores in groups 2 and 3 were consistently 2-3 times the MID. In the low response group, at least 50% of the patients achieved or exceeded the MID with treatments 2-6. AEs were similar across all response groups and consistent across repeated treatments. CONCLUSION Patients with NDO with a ≥50% UI reduction after their first onabotulinumtoxinA treatment continued to experience consistent improvements in UI and quality of life with subsequent treatments over the duration of 4 years. A <50% UI reduction after first treatment did not necessarily predict low response with subsequent treatments. Thus, these results underscore the importance of attempting at least a second treatment with onabotulinumtoxinA before deeming patients unsuitable for onabotulinumtoxinA therapy.
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Affiliation(s)
| | | | - Philip Aliotta
- Western New York Urology Associates, LLC, Cheektowaga, NY, USA
| | - David Castro-Diaz
- Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Bertil Blok
- Erasmus Medical Centre, Rotterdam, The Netherlands
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Stothers L, Tsang B, Nigro M, Lazare D, Macnab A. An integrative review of standardized clinical evaluation tool utilization in anticholinergic drug trials for neurogenic lower urinary tract dysfunction. Spinal Cord 2016; 54:1114-1120. [PMID: 27241452 PMCID: PMC5308214 DOI: 10.1038/sc.2016.63] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/01/2016] [Accepted: 03/21/2016] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN To review prospective and randomized trials studying anticholinergic therapy for neurogenic bladder in SCI to identify whether trials included standardized clinical evaluation tools and reporting measures now recognized to enhance clinical trial data. METHODS A systematic search via EMBASE, MEDLINE, CENTRAL, CINAHL (Cumulative Index to Nursing and Allied Health Literature), HTA (Health Technology Assessment), CMR (Comprehensive Microbial Resource), HAPI (Health and Psychosocial Instruments) and PsycINFO using the key term spinal cord injury crossed with oxybutynin, tolterodine, darifenacin, solifenacin, fesoterodine, trospium chloride, propiverine, propantheline and anticholinergic(s) for 1946-2015 inclusive. We then collated whether standardized clinical tools, measures and descriptors were used within each study identified: American Spine Injury Association (ASIA) impairment scale; symptom scores validated in SCI; technical methodology for urodynamics/video urodynamics; urinary diaries; and standardized urologic terminology. RESULTS A total of 1225 entries with 610 unique articles were identified, 14 randomized and 16 prospective studies. In 6/30 the population comprised SCI patients with neurogenic bladder alone; the remainder included mixed neurogenic etiologies. Classification using the ASIA impairment scale was used in <10% of studies; none used symptom scores validated in SCI; <50% reported urodynamic test methodology fully, incorporated urinary diaries or used International Continence Society Standardization Subcommittee urinary tract terminology. CONCLUSION Integrative review of trials from 1946 to 2015 identified infrequent use of standardized clinical evaluation tools and reporting measures. Data from future trials evaluating therapies for neurogenic bladder would likely be more applicable to specific SCI patients if current standardized classification and descriptors now available were used consistently: for example, the ASIA scale, symptom scores validated in SCI, standardized urodynamic methodology, urinary diaries and urinary tract terminology. Studies recruiting SCI patients exclusively would also provide additional benefit.
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Affiliation(s)
- L Stothers
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Associate Member Department of Obstetrics and Gynaecology and School of Population and Public Health University of British Columbia, Vancouver, BC, Canada
| | - B Tsang
- St Andrews University, Fife, Scotland, UK
| | - M Nigro
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - D Lazare
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - A Macnab
- Department of Urologic Sciences and Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Fernández-Cuadros ME, Nieto-Blasco J, Geanini-Yagüez A, Ciprián-Nieto D, Padilla-Fernández B, Lorenzo-Gómez MF. Male Urinary Incontinence. Am J Mens Health 2016; 10:NP127-NP135. [DOI: 10.1177/1557988315590653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
The aim of the current study was to determine the demographic characteristics and risk factors associated with male urinary incontinence (UI) and to assess the effectiveness and the effect on the quality-of-life of a pelvic floor muscle training (PFMT) protocol with electromyography-biofeedback (EMG-BFB) with surface electrodes. A prospective, quasi-experimental before-and-after study with a sample of 61 men out of 372 patients referred to the Pelvic Floor Unit from October 2005 to June 2012 was performed. The protocol consisted of 20 sessions of EMG-BFB supervised by a physiotherapist twice a week. The session durations were 30 minutes (118 work/rest cycles of pelvic muscles). Work lasted 3 seconds and rest 7 seconds. Patients were given standards of conduct and questionnaires (International Consultation on Incontinence–Short Form and Incontinence Quality-of-Life Measure) at the beginning and at the end of the treatment. The average age was 64.85 ± 14.34 years; 44.3% ( n = 27) had benign prostatic hypertrophy, 41.9% ( n = 25) had prostate malignant neoplasm, 86.9% ( n = 53) had undergone prostatectomy, 16.4% ( n = 10) had undergone abdominal surgery. Abdominal surgery and radical prostatectomy were significantly associated with UI ( p < .05). Stress urinary incontinence was the most common type of UI (86.67%), followed by mixed urinary incontinence (8.33%) and urge urinary incontinence (5%). A significant improvement ( p < .05) in both International Consultation on Incontinence–Short Form and Incontinence Quality-of-Life Measure questionnaires was observed when making comparisons regarding the results before and after the EMG-BFB treatment protocol. These results support that male UI is significantly associated with urological and abdominal surgery (including radical prostatectomy) and that EMG-BFB for PFMT improves incontinence and quality of life (social embarrassment, limiting behavior, and psychosocial impact) in the three types of UI on an overall basis.
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Affiliation(s)
- Marcos E. Fernández-Cuadros
- Department of Rehabilitation and Physical Medicine, Santa Cristina’s University Hospital, Madrid, Spain
- Department of Rehabilitation and Physical Medicine, Santisima Trinidad’s Foundation Hospital, Salamanca, Spain
| | - Javier Nieto-Blasco
- Department of Rehabilitation and Physical Medicine. University Healthcare Complex of Salamanca, Spain
| | - Antonia Geanini-Yagüez
- Department of Rehabilitation and Physical Medicine. University Healthcare Complex of Salamanca, Spain
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Milinis K, Tennant A, A. Young C. Rasch analysis of SF-Qualiveen in multiple sclerosis. Neurourol Urodyn 2016; 36:1161-1166. [DOI: 10.1002/nau.23081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/09/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Kristijonas Milinis
- University of Liverpool; Liverpool United Kingdom
- The Walton Centre NHS Foundation Trust; Liverpool United Kingdom
| | | | - Carolyn A. Young
- University of Liverpool; Liverpool United Kingdom
- The Walton Centre NHS Foundation Trust; Liverpool United Kingdom
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Fougere RJ, Currie KD, Nigro MK, Stothers L, Rapoport D, Krassioukov AV. Reduction in Bladder-Related Autonomic Dysreflexia after OnabotulinumtoxinA Treatment in Spinal Cord Injury. J Neurotrauma 2016; 33:1651-7. [PMID: 26980078 PMCID: PMC5035837 DOI: 10.1089/neu.2015.4278] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Bladder-related events, including neurogenic detrusor overactivity, are the leading cause of autonomic dysreflexia in spinal cord injured individuals. Self-reported autonomic dysreflexia is reduced following onabotulinumtoxinA treatment for neurogenic detrusor overactivity; however, none of these trials have assessed autonomic dysreflexia events using the clinical cutoff of an increase in systolic blood pressure ≥20 mm Hg. This study used a prospective, open-labelled design from 2013 to 2014 to quantitatively assess the efficacy of one cycle 200 U intradetrusor-injected onabotulinumtoxinA (20 sites) on reducing the severity and frequency of bladder-related autonomic dysreflexia events and improving quality of life. Twelve men and five women with chronic, traumatic spinal cord injuries at or above the sixth thoracic level, and concomitant autonomic dysreflexia and neurogenic detrusor overactivity, underwent blood pressure monitoring during urodynamics and over a 24 h period using ambulatory blood pressure monitoring pre- and 1 month post-treatment. Post-onabotulinumtoxinA, autonomic dysreflexia severity was reduced during urodynamics (systolic blood pressure increase: 42 ± 23 mm Hg vs. 20 ± 10 mm Hg, p < 0.001) and during bladder-related events across the 24 h period (systolic blood pressure increase: 49 ± 2 mm Hg vs. 26 ± 22 mm Hg, p = 0.004). Frequency of 24 h bladder-related autonomic dysreflexia events was also decreased post-onabotulinumtoxinA (4 ± 2 events vs. 1 ± 1 events, p < 0.001). Autonomic dysreflexia and incontinence quality of life indices were also improved post-onabotulinumtoxinA (p < 0.05). Intradetrusor injections of onabotulinumtoxinA for the management of neurogenic detrusor overactivity in individuals with high level spinal cord injuries decreased the severity and frequency of bladder-related episodes of autonomic dysreflexia, and improved bladder function and quality of life.
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Affiliation(s)
- Renée J Fougere
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Katharine D Currie
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Mark K Nigro
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,2 Department of Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Lynn Stothers
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,2 Department of Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Daniel Rapoport
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,2 Department of Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Andrei V Krassioukov
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,2 Department of Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,3 Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,4 G.F. Strong Rehabilitation Centre , Vancouver, British Columbia, Canada
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Abstract
Many interventions for neurogenic bladder patients are directed towards improving quality of life (QOL). Patient reported outcome measures (PROMs) are the primary method of evaluating QOL, and they provide an important quantification of symptoms which can't be measured objectively. Our goal was to review general measurement principles, and identify and discuss PROMs relevant to neurogenic bladder patients. We identify two recent reviews of the state of the literature and updated the results with an additional Medline search up to September 1, 2015. Using the previous identified reviews, and our updated literature review, we identified 16 PROMs which are used for the assessment of QOL and symptoms in neurogenic bladder patients. Several are specifically designed for neurogenic bladder patients, such as the Qualiveen (for neurogenic bladder related QOL), and the Neurogenic Bladder Symptom Score (NBSS) (for neurogenic bladder symptoms). We also highlight general QOL measures for patients with multiple sclerosis (MS) and spinal cord injury (SCI) which include questions about bladder symptoms, and incontinence PROMs which are commonly used, but not specifically designed for neurogenic bladder patients. It is essential for clinicians and researchers with an interest in neurogenic bladder to be aware of the current PROMs, and to have a basic understanding of the principals of measurement in order to select the most appropriate one for their purpose.
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Affiliation(s)
- Roderick Clark
- 1 Department of Surgery, Western University, London, ON N6A 4V2, Ontario, Canada ; 2 Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Blayne Welk
- 1 Department of Surgery, Western University, London, ON N6A 4V2, Ontario, Canada ; 2 Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Denys P, Del Popolo G, Amarenco G, Karsenty G, Le Berre P, Padrazzi B, Picaut P. Efficacy and safety of two administration modes of an intra-detrusor injection of 750 units dysport® (abobotulinumtoxinA) in patients suffering from refractory neurogenic detrusor overactivity (NDO): A randomised placebo-controlled phase IIa study. Neurourol Urodyn 2016; 36:457-462. [PMID: 26756554 DOI: 10.1002/nau.22954] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/14/2015] [Indexed: 01/23/2023]
Abstract
AIMS Assess the efficacy and safety of abobotulinumtoxinA (Dysport®) in adult patients with neurogenic detrusor overactivity (NDO). METHODS This Phase IIa, international, multicentre, double-blind, randomised, placebo controlled, pilot study enrolled 47 patients with NDO and urinary incontinence resulting from spinal cord injury (SCI) or multiple sclerosis (MS). Patients were treated with 15 intra-detrusor injections of Dysport 750 U or the equivalent placebo (n = 16 and 7) or 30 injections of Dysport 750 U or the equivalent placebo (n = 17 and 7). Primary endpoint was change from baseline in mean number of daily incontinence episode frequency (IEF) at day 84. Secondary endpoints included change from baseline in urodynamic parameters and quality of life (QOL). A safety assessment was also conducted. RESULTS Adjusted mean changes from baseline in IEF were -3.2 (-76%) and -1.7 (-15%) for 15 injections Dysport and placebo groups, respectively, (P = 0.1103) and -3.2 (-88%) and -2.6 (-73%) for 30 injections Dysport and placebo groups, respectively, (P = 0.0686). Statistically significant improvements in maximum cystometric capacity, maximum detrusor pressure and volume at first contraction were reported in the Dysport groups compared with placebo (P < 0.05). Improvements in QOL were reported. Three muscle weakness episodes were reported as serious adverse events in two tetraplegic and one paraplegic patient, all in the 15 injections Dysport group. CONCLUSIONS Both 15 and 30 injections administration modes of Dysport decreased daily IEF and resulted in significant improvements in urodynamic parameters in NDO patients with MS or SCI. Reduction to 15 injection sites did not appear to be associated with any impact on efficacy. Neurourol. Urodynam. 36:457-462, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Pierre Denys
- Department of Physical Medicine and Rehabilitation, Hôpital Raymond-Poincaré AP-HP, Garches, France
| | - Giulio Del Popolo
- Department of Neurourology, Careggi University Hospital, Florence, Italy
| | | | - Gilles Karsenty
- Department of Urology, Hôpital de la Conception, Marseille, France
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Kennelly M, Dmochowski R, Schulte-Baukloh H, Ethans K, Del Popolo G, Moore C, Jenkins B, Guard S, Zheng Y, Karsenty G. Efficacy and safety of onabotulinumtoxinA therapy are sustained over 4 years of treatment in patients with neurogenic detrusor overactivity: Final results of a long-term extension study. Neurourol Urodyn 2015; 36:368-375. [PMID: 26607743 DOI: 10.1002/nau.22934] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/09/2015] [Indexed: 11/06/2022]
Abstract
AIMS To present final efficacy/safety results from a prospective, long-term extension trial of onabotulinumtoxinA for urinary incontinence (UI) due to neurogenic detrusor overactivity (NDO); patients received treatment for up to 4 years. METHODS Patients who completed a 52-week, phase III trial of onabotulinumtoxinA for NDO were eligible to enter a 3-year, multicenter, open-label extension study of intradetrusor onabotulinumtoxinA (200U or 300U). Patients were treated "as needed" based on their request and fulfillment of prespecified qualification criteria (≥12 weeks since previous treatment and a UI episode threshold). Assessments included change from study baseline in UI episodes/day (primary efficacy measure), volume/void, and Incontinence Quality of Life (I-QOL) total score (week 6); duration of effect; adverse events (AEs); and initiation of de novo clean intermittent catheterization (CIC). Data are presented for up to six treatments. RESULTS OnabotulinumtoxinA 200U consistently reduced UI episodes/day; reductions from baseline ranged from -3.2 to -4.1 across six treatments. Volume/void consistently increased, nearly doubling after treatment. I-QOL improvements were consistently greater than twice the minimally important difference (+11 points). Overall median duration of effect was 9.0 months (200U). Results were similar for onabotulinumtoxinA 300U. Most common AEs were urinary tract infections and urinary retention. De novo CIC rates were 29.5, 3.4, and 6.0% (200U), and 43.0, 15.0, and 4.8% (300U) for treatments 1-3, respectively; de novo CIC rates were 0% for treatments 4-6. CONCLUSIONS OnabotulinumtoxinA treatments consistently improve UI, volume/void, and QOL in patients with UI due to NDO in this 4-year study, with no new safety signals. Neurourol. Urodynam. 36:368-375, 2017. © 2015 The Authors. Neurourology and Urodynamics Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Michael Kennelly
- Department of Urology, Carolinas Rehabilitation, Charlotte, North Carolina
| | - Roger Dmochowski
- Department of Urological Surgery, Vanderbilt University, Nashville, Tennessee
| | | | - Karen Ethans
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Giulio Del Popolo
- Department of Neurourology, Careggi University Hospital, Florence, Italy
| | - Courtenay Moore
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Yan Zheng
- Allergan, Inc., Bridgewater, New Jersey
| | - Gilles Karsenty
- Department of Urology, Aix-Marseille Université, Marseille, France
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Castejón N, Khalaf K, Ni Q, Cuervo J, Patrick DL. Psychometric properties of the incontinence utility index among patients with idiopathic overactive bladder: data from two multicenter, double-blind, randomized, Phase 3, placebo-controlled clinical trials. Health Qual Life Outcomes 2015; 13:116. [PMID: 26231052 PMCID: PMC4522067 DOI: 10.1186/s12955-015-0306-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overactive bladder is a prevalent and burdensome condition. Generic utility measures may fail to reflect its full impact on patients' health status. The Incontinence Utility Index (IUI) is a community-based preference index derived from the Incontinence Quality of Life Questionnaire (I-QOL) developed to value health states related to urinary symptoms in patients with neurogenic detrusor overactivity. This study assessed the measurement properties of the IUI in patients with idiopathic overactive bladder (OAB). METHODS Data were used from two clinical trials which recruited patients with OAB whose symptoms were inadequately managed with ≥ 1 anticholinergic medication. Psychometric evaluation included: Differential Item Functioning (DIF) analysis, concordance between I-QOL and IUI (Intraclass correlation coefficient [ICC], criterion and convergent validity according to relevant patient reported outcomes and clinical variables (Spearman's correlation coefficient, rho), responsiveness, and agreement between utility measures (ICC and Bland-Altman method). RESULTS A total of 1,105 idiopathic OAB patients were included. Mean age (range) was 60.4 years (18-90), 87.8% (n = 970) were female. DIF was identified in 3 items, none of which are contained in the IUI. ICC (CI95%) was 0.944 (0.936-0.950). Statistically significant differences (p < 0.001) were found in IUI scores for patients improving according to the Treatment Benefit Scale (TBS). Moderate to strong correlations (rho > |0.6|) were found in the expected direction with daily incontinence, urgency episodes and disease-specific domains of King's Health Questionnaire (KHQ). Low to moderate correlations (rho:<|0.6|) were found with Short Form version 2 (SF-12v2) summary components. A large effect size was found for patients reporting improvement (0.98-1.21) or great improvement (1.87-2.56) in the TBS, as well as in patients responding to treatment (1.19-2.40). Across utility measures, directional trends were consistent with OAB symptom profile, however, a lack of agreement in absolute values was observed. CONCLUSIONS The IUI presents good psychometric properties for valuing the impact of UI-related problems in idiopathic OAB patients. TRIAL REGISTRATION ClinicalTrials.gov: NCT00910845 and NCT00910520.
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Affiliation(s)
- Nacho Castejón
- LA-SER Outcomes, C/ Azcárraga 12 A 33010 Oviedo, Asturias, Spain.
| | | | | | - Jesús Cuervo
- LA-SER Outcomes, C/ Azcárraga 12 A 33010 Oviedo, Asturias, Spain.
| | - Donald L Patrick
- Department of Health Services, University of Washington, Seattle, WA, USA.
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Lee KS, Choo MS, Seo JT, Oh SJ, Kim HG, Ng K, Lee KJ, Tan JT, Kim JC. Impact of overactive bladder on quality of life and resource use: results from Korean Burden of Incontinence Study (KOBIS). Health Qual Life Outcomes 2015; 13:89. [PMID: 26113125 PMCID: PMC4480453 DOI: 10.1186/s12955-015-0274-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/25/2015] [Indexed: 01/22/2023] Open
Abstract
Background To evaluate the impact of overactive bladder (OAB) on quality of life (QOL), resource use and productivity loss in patients recruited from six hospitals in Korea. Methods This cross-sectional survey recruited 625 OAB patients between July to December 2013. Patients were categorised into four groups based on the average number of urinary incontinence (UI) episodes over the past three days (0, 1, 2–3 and ≥4 UI/day). QOL was measured using the Incontinence-Specific Quality of Life Instrument (I-QOL), the Overactive Bladder Questionnaire (OAB-q), and a generic health-related utility instrument (EQ-5D). Information on hospital and clinic visit frequency, and continence pads use were also collected. Work productivity was assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire. Between group differences were assessed using ANOVA. Multivariable regression analyses were performed to examine the independent effects of OAB symptoms on QOL. Results Severity of UI showed a significant linear relationship with QOL, with clinically meaningful differences between each UI severity category. Compared to the dry category, patients in the most severe category (≥4 UI/day) had significantly lower I-QOL scores (69.8 vs 42.6; p < 0.0001), greater symptom bother on the OAB-q (30.4 vs 64.6; p < 0.0001), and poorer EQ-5D utility (0.848 vs 0.742; p < 0.001). Multivariable analyses showed that UI severity, frequency, urgency, and nocturia are independently associated with poorer QOL. Incontinence severity is also significantly associated with cost of incontinence pads (p < 0.0001), and a greater interference with work and regular activities (p = 0.001), however, no significant difference in hospital and clinic visits were observed. Conclusion Severity of UI is a key contributor to the disease burden of OAB in Korean patients, even after taking into account the impact of other symptoms associated with OAB. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0274-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kyu Sung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, South Korea.
| | - Myung Soo Choo
- Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro, 43-Gil, Songpa-Gu, Seoul, South Korea.
| | - Ju Tae Seo
- Cheil General Hospital, Dankoo University College of Medicine, 1-19 Mukjeong-Dong, Jung-Gu, Seoul, South Korea.
| | - Seung June Oh
- Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, South Korea.
| | - Hyeong Gon Kim
- Konkuk University School of Medicine, Konkuk University Medical Center, Gwangjin-Gu, Seoul, South Korea.
| | - Kwong Ng
- Allergan APAC, Pasir Panjang Road, MBC, West Building #09-25, Singapore, 117439, Singapore.
| | - Kyung Jin Lee
- Allergan Korea, GT Tower 14F, 1317-23, Seocho-dong, Seocho-gu, Seoul.
| | - Jonathan T Tan
- Allergan APAC, Pasir Panjang Road, MBC, West Building #09-25, Singapore, 117439, Singapore.
| | - Joon Chul Kim
- Bucheon St.Mary's Hospital, 2 Sosa-Dong, Wonmi-Gu, Gyeonggido, South Korea.
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Nicholas RS, Friede T, Hollis S, Young CA. WITHDRAWN: Anticholinergics for urinary symptoms in multiple sclerosis. Cochrane Database Syst Rev 2015; 2015:CD004193. [PMID: 26043867 PMCID: PMC10666567 DOI: 10.1002/14651858.cd004193.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This review has been withdrawn for the following reasons: ‐ a review author contravenes Cochrane's Commercial Sponsorship Policy. This policy ensures the independence of Cochrane reviews by making sure that there is no bias associated with commercial conflicts of interest in the conduct of Cochrane reviews. The author was employed by the biopharmaceutical company AstraZeneca and cannot say with certainty that the company did not produce or have any financial interest in the interventions in this review ‐ the review is substantially out of date To view the published versions of this article, please click the 'Other versions' tab. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Richard S Nicholas
- Charing Cross HospitalWest London Neurosciences CentreFulham Palace RoadLondonUKW6 8RF
| | - Tim Friede
- Universitatsmedizin GöttingenAbteilung fur Innere Medizin 1GöttingenGermany
| | - Sally Hollis
- University of Nottinghamc/o Cochrane Skin GroupKing's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Carolyn A Young
- The Walton Centre NHS Foundation TrustLower LaneFazakerleyLiverpoolUKL9 7LJ
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